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General NPI Number Information
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NPI Number | 1619027760
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Entity Type | Individual
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Provider Name | DEREK RYDEN HANEY P.T., DPT
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2269 NORTHWEST LOOP
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City | STEPHENVILLE
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State | TX
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Zip | 76401
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Country | US
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Telephone | 254-965-2040
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Fax | 254-965-7394
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Provider Business Mailing Address
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Address Line | 2269 NORTHWEST LOOP
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City | STEPHENVILLE
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State | TX
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Zip | 76401
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Country | US
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Telephone | 254-965-2040
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Fax | 254-965-2723
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3102935
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License Number State | TX
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